Randomized Phase II Study of Cisplatin and Etoposide Versus Temozolomide and Capecitabine in Patients With Advanced Poorly Differentiated (G3) Non-Small Cell Gastrointestinal Neuroendocrine Carcinomas
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 67
- 试验地点
- 1,333
- 主要终点
- PFS
研究概览
简要总结
This randomized phase II trial studies how well temozolomide and capecitabine work compared to standard treatment with cisplatin or carboplatin and etoposide in treating patients with neuroendocrine carcinoma of the gastrointestinal tract or pancreas that has spread to other parts of the body (metastatic) or cannot be removed by surgery. Drugs used in chemotherapy, such as temozolomide, capecitabine, cisplatin, carboplatin and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Certain types of neuroendocrine carcinomas may respond better to treatments other than the current standard treatment of cisplatin and etoposide. It is not yet known whether temozolomide and capecitabine may work better than cisplatin or carboplatin and etoposide in treating patients with this type of neuroendocrine carcinoma, called non-small cell neuroendocrine carcinoma.
详细描述
PRIMARY OBJECTIVES:
I. To assess the progression free survival (PFS) of platinum (cisplatin or carboplatin) and etoposide versus the PFS of temozolomide and capecitabine in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas.
SECONDARY OBJECTIVES:
I. To assess the response rate (RR) of platinum (cisplatin or carboplatin) and etoposide versus the RR of temozolomide and capecitabine in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas.
II. To assess the overall survival (OS) of platinum (cisplatin or carboplatin) and etoposide versus the OS of temozolomide and capecitabine in patients with advanced G3 non-small cell gastroenteropancreatic neuroendocrine carcinomas.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients must have a locally advanced and unresectable or metastatic gastroenteropancreatic neuroendocrine carcinoma that is either known or suspected to be of gastrointestinal (GI) origin; primary tumors arising from the lung, gynecologic organs or prostate are not permitted
- •Patients must have pathologically/histologically confirmed tumor of non-small cell histology
- •Patients must have a Ki-67 proliferative index of 20-100% OR at least 10 mitotic figures per 10 high powered fields
- •Patients must have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria; baseline measurements and evaluations of all sites of disease must be obtained within 4 weeks prior to randomization and must be acquired by multiphasic computed tomography (CT) or contrast magnetic resonance imaging (MRI)
- •NOTE: positron emission tomography (PET)-CT scans are allowed provided the CT portion of the exam is equivalent to a diagnostic CT scan and includes both oral and IV contrast
- •Any prior surgeries must have been completed at least 4 weeks prior to randomization
- •Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- •Patients may not be receiving any other investigational agents while on study treatment
- •Patients may not be receiving Coumadin while on treatment; other anticoagulants are allowed
- •Leukocytes >= 3,000/mm^3
- •Absolute neutrophil count >= 1,500/mm^3
- •Hemoglobin >= 9 g/dL
- •Platelets >= 100,000/mm^3
- •Total bilirubin =< institutional upper limit of normal (ULN) or =< 1.5 X institutional ULN (if the patient has liver metastases)
- •Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X institutional ULN or (=< 5 X institutional ULN if the patient has liver metastases)
- •Serum creatinine =< 1.5 X institutional ULN and creatinine clearance >= 60 ml/min
- •NOTE: creatinine clearance must be calculated using the Cockcroft-Gault equation
- •Patients must have a life expectancy of >= 12 weeks as determined clinically by the treating physician
- •Patients with impaired decision-making capacity may participate in the study if a legal authorized representative is available to consent
- •Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception or to abstain from sexual intercourse for the duration of their participation in the study
- •Patients must be able to swallow pills
- •Patients must be able to tolerate CT or magnetic resonance (MR) imaging including contrast agents as required for the treatment and the protocol
排除标准
- •Patients may not have had any prior systemic treatment for this malignancy (for example chemotherapy or somatostatin analogues); prior palliative radiation is permitted but radiated lesions may not be used for measurement
- •Patients may not have received any of the protocol agents within 5 years prior to randomization
- •Patients with brain metastases (either remote or current) or presence of carcinomatous meningitis are not eligible
- •Patients with known dihydropyrimidine dehydrogenase (DPD) deficiency will be excluded
- •Patients must NOT have active or uncontrolled infection, symptomatic heart failure, unstable angina pectoris, cardiac arrhythmia or a serious psychiatric illness/social situation that would limit compliance with study requirements
- •Patients must NOT have a history of allergic reactions attributed to compounds of similar chemical or biochemical composition to cisplatin, carboplatin, etoposide, temozolomide or capecitabine
- •Patients must NOT have absorption issues that would limit the ability to absorb study agents
- •Patients with a history of the following within =< 12 months of study entry are not eligible:
- •Arterial thromboembolic events
- •Unstable angina
- •Myocardial Infarction
- •Patients with symptomatic peripheral vascular disease are not eligible
- •Patients must NOT have previous or concurrent malignancy; exceptions are made for patients who meet any of the following conditions:
- •Non-melanoma skin cancer, in situ cervical cancer, superficial bladder cancer, or breast cancer in situ OR
- •Prior malignancy completely excised or removed and patient has been continuously disease free for > 5 years OR
- •Prior malignancy cured by non-surgical modalities and patient has been continuously disease free for > 5 years
- •Women must not be pregnant or breast-feeding
- •All females of childbearing potential must have a blood test or urine study within 2 weeks prior to randomization to rule out pregnancy
- •A female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
- •Patients who are known to have human immunodeficiency virus (HIV) or are on combination antiretroviral therapy are ineligible
研究组 & 干预措施
Arm A (capecitabine, temozolomide)
Patients receive capecitabine PO BID on days 1-14 and temozolomide PO QD on days 10-14. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Laboratory Biomarker Analysis (Other)
Arm B (cisplatin, carboplatin, etoposide)
Patients receive cisplatin IV on days 1-3 or carboplatin IV on day 1. Patients also receive etoposide IV on days 1-3. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
干预措施: Laboratory Biomarker Analysis (Other)
Arm B (cisplatin, carboplatin, etoposide)
Patients receive cisplatin IV on days 1-3 or carboplatin IV on day 1. Patients also receive etoposide IV on days 1-3. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
干预措施: Carboplatin (Drug)
Arm B (cisplatin, carboplatin, etoposide)
Patients receive cisplatin IV on days 1-3 or carboplatin IV on day 1. Patients also receive etoposide IV on days 1-3. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
干预措施: Etoposide (Drug)
Arm B (cisplatin, carboplatin, etoposide)
Patients receive cisplatin IV on days 1-3 or carboplatin IV on day 1. Patients also receive etoposide IV on days 1-3. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
干预措施: Cisplatin (Drug)
Arm A (capecitabine, temozolomide)
Patients receive capecitabine PO BID on days 1-14 and temozolomide PO QD on days 10-14. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Temozolomide (Drug)
Arm A (capecitabine, temozolomide)
Patients receive capecitabine PO BID on days 1-14 and temozolomide PO QD on days 10-14. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Capecitabine (Drug)
结局指标
主要结局
PFS
时间窗: Time from randomization to documented progression or death without progression, assessed up to 1 year
Kaplan-Meier estimates will be used for time-to-event distribution. PFS by arm will be compared using one-sided stratified log-rank tests. Stratified Cox?s proportional hazards models will be used to estimate hazard ratios.
Progression-free Survival (PFS)
时间窗: assessed at baseline, every 8 weeks until treatment completion, then every 3 months within 2 years and every 6 months within 3-5 years from randomization until disease progression, up to 5 years from study registration
PFS is defined as the time from randomization to documented progression or death without progression. PFS is censored at the date of last disease evaluation. The study was closed for futility in 2021 after the 2021 Spring DSMC meeting, which found that the boundary for futility had been met (ie, temozolomide and capecitabine did not appear to be superior to platinum and etoposide chemotherapy). As the interim analysis finding led to the conclusion of the study, no PFS stratified logrank test was conducted with the data extracted on April 23rd, 2025 for the final analysis, that was presented here.
次要结局
- Incidence of toxicity, graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0(Up to 30 days after last dose of protocol therapy)
- OS(Time from randomization to death from any cause, assessed up to 5 years)
- Response rate (complete response or partial response) by RECIST 1.1(Up to 5 years)
- Overall Survival (OS)(assessed at baseline, then every 3 months within 2 years from randomization, and every 6 months if patient is 3-5 years from randomization, up to 5 years from randomization)
- Objective Response Rate (ORR)(assessed at baseline, every 8 weeks until treatment completion, then every 3 months within 2 years and every 6 months within 3-5 years, up to 5 years from registration; the best response among all assessments was considered as objective response)